RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01371
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20030708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Undesignated Seaman Recruit, medically separated for “sinus tarsi syndrome left,” with a disability rating of 10%.  

CI CONTENTION:  She requests review of all conditions.  Her complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20030603	VARD - 20030821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sinus Tarsi Syndrome Left	5299-5003	10%	No VA Placement	
Bilateral Mid Foot Stress Reactions	Cat III	Bilateral Mid Foot Stress Reactions	5284	NSC	20030626	
Left Second Metatarsal Stress Fracture	Cat III	Left Second Metatarsal Stress Fracture	5283	30%	20030626	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Left Ankle Sinus Tarsi Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s left sinus tarsi syndrome began in December 2002 after a twisting injury to the ankle.  Despite treatment, the left ankle and foot condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  Initial radiographic evaluation (X-Rays) of the ankle and foot in March 2003 were normal, however, further imaging (X-Rays and bone scan) documented a 2nd digit (metatarsal) stress fracture with mid foot stress reactions.  

The MEB NARSUM examination on 23 April 2003, 3 months prior to separation, noted complaints of inability to run or walk for prolonged periods.  The physical examination showed normal heel, toe and tandem gait, no tenderness at the lateral ankle, and no evidence of instability or laxity.  Dorsiflexion was to 20 degrees (normal), and plantar flexion was to 40 degrees (normal 45).  The MEB NARSUM addendum examination on 2 May 2003, 2 months prior to separation, showed tenderness of the 2nd metatarsal, “adequate” range of motion with pain in the lateral ankle (sinus tarsi area).  Strength was normal (5/5) with no evidence of instability.  

At the 15 May 2003 General Medicine VA Compensation and Pension (C&P) evaluation, 2 months prior to separation, the CI reported daily pain that persisted while sitting and resting.  The examiner noted a normal gait and deferred the rest of the examination to the orthopedic examiner.  At the 26 June 2003 orthopedic C&P evaluation, 2 weeks before separation, the CI reported pain with inability to run, and that wear of an ankle brace decreased the pain.  The physical examination showed tenderness and swelling over the distal 2nd digit (proximal to the toe) with any motion causing pain.  Toe dorsiflexion was to 45 degrees and plantar flexion was to 30 degrees without pain.  Ankle dorsiflexion and plantar flexion were normal without pain or weakness.  There was moderate lack of endurance with no lack of coordination nor evidence of instability.  Gait was normal.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the left sinus tarsi syndrome 10%, coded 5299-5003 (analogous to degenerative arthritis).  The PEB also listed the “bilateral mid foot stress reactions and left 2nd metatarsal stress fracture” as category III conditions (conditions that are not separately unfitting and do not contribute to the unfitting condition).  There were various related diagnoses contributing to the disability in this case; and, panel members first agreed that there were no separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  The VA did not rate the sinus tarsi syndrome, but rated instead the left 2nd metatarsal stress fracture condition at 30%, coded 5283 (tarsal, or metatarsal bones, malunion or nonunion of) based on the C&P examination 2 weeks before separation, citing severe symptoms.  The panel considered the evidence for a higher rating.  There was evidence of painful motion of the ankle at the May 2003 MEB NARSUM addendum examination and the VA C&P examination that would support a 10% rating.  There was no evidence of limitations of ankle dorsiflexion, or toe dorsiflexion (5278), or marked pronation or abduction deformities (5276) for higher rating under analogous coding.  Although there was evidence of tenderness and swelling of the 2nd metatarsal fracture at the orthopedic VA C&P examination, there was no evidence of gait abnormalities that would support a ‘moderately severe’ or ‘severe’ rating under 5283 or 5284 (foot injuries, other).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the left ankle and foot condition.  The panel also concluded that the contended “bilateral mid foot stress reactions and left 2nd metatarsal stress fracture” conditions could not be reasonably justified as separately unfitting nor could they be separately rated without violating VASRD §4.14. Therefore, there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the left ankle and foot condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral mid foot stress reaction and left second metatarsal stress fracture conditions, the panel unanimously agrees that it cannot recommend them for additional disability rating.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered: 

Exhibit A.  DD Form 294, dated 20150617, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 10 May 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

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